The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study
Abstract Background Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to i...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00499-3 |
| _version_ | 1827956871285178368 |
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| author | Belinda De Simone Yoram Kluger Ernest E. Moore Massimo Sartelli Fikri M. Abu-Zidan Federico Coccolini Luca Ansaloni Giovanni D. Tebala Salomone Di Saverio Isidoro Di Carlo Boris E. Sakakushev Luigi Bonavina Michael Sugrue Joseph M. Galante Rao Ivatury Edoardo Picetti Mircea Chirica Imtiaz Wani Miklosh Bala Ibrahima Sall Andrew W. Kirkpatrick Vishal G. Shelat Emmanouil Pikoulis Ari Leppäniemi Edward Tan Richard P. G. ten Broek Solomon Gurmu Beka Andrey Litvin Elie Chouillard Raul Coimbra Yunfeng Cui Nicola De’ Angelis Gabriele Sganga Philip F. Stahel Vanni Agnoletti Alessia Rampini WSES TACS panel of experts Mario Testini Francesca Bravi Ronald V. Maier Walter L. Biffl Fausto Catena |
| author_facet | Belinda De Simone Yoram Kluger Ernest E. Moore Massimo Sartelli Fikri M. Abu-Zidan Federico Coccolini Luca Ansaloni Giovanni D. Tebala Salomone Di Saverio Isidoro Di Carlo Boris E. Sakakushev Luigi Bonavina Michael Sugrue Joseph M. Galante Rao Ivatury Edoardo Picetti Mircea Chirica Imtiaz Wani Miklosh Bala Ibrahima Sall Andrew W. Kirkpatrick Vishal G. Shelat Emmanouil Pikoulis Ari Leppäniemi Edward Tan Richard P. G. ten Broek Solomon Gurmu Beka Andrey Litvin Elie Chouillard Raul Coimbra Yunfeng Cui Nicola De’ Angelis Gabriele Sganga Philip F. Stahel Vanni Agnoletti Alessia Rampini WSES TACS panel of experts Mario Testini Francesca Bravi Ronald V. Maier Walter L. Biffl Fausto Catena |
| author_sort | Belinda De Simone |
| collection | DOAJ |
| description | Abstract Background Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. Methods This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Results Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. Conclusion The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients. Graphical Abstract |
| first_indexed | 2024-04-09T15:11:26Z |
| format | Article |
| id | doaj.art-0e548d4f695345d0ad6acd573f6bb6e4 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-09T15:11:26Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-0e548d4f695345d0ad6acd573f6bb6e42023-04-30T11:11:01ZengBMCWorld Journal of Emergency Surgery1749-79222023-04-0118111010.1186/s13017-023-00499-3The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus studyBelinda De Simone0Yoram Kluger1Ernest E. Moore2Massimo Sartelli3Fikri M. Abu-Zidan4Federico Coccolini5Luca Ansaloni6Giovanni D. Tebala7Salomone Di Saverio8Isidoro Di Carlo9Boris E. Sakakushev10Luigi Bonavina11Michael Sugrue12Joseph M. Galante13Rao Ivatury14Edoardo Picetti15Mircea Chirica16Imtiaz Wani17Miklosh Bala18Ibrahima Sall19Andrew W. Kirkpatrick20Vishal G. Shelat21Emmanouil Pikoulis22Ari Leppäniemi23Edward Tan24Richard P. G. ten Broek25Solomon Gurmu Beka26Andrey Litvin27Elie Chouillard28Raul Coimbra29Yunfeng Cui30Nicola De’ Angelis31Gabriele Sganga32Philip F. Stahel33Vanni Agnoletti34Alessia Rampini35WSES TACS panel of expertsMario Testini36Francesca Bravi37Ronald V. Maier38Walter L. Biffl39Fausto Catena40Department of General and Emergency Surgery, Guastalla Hospital, AUSL Reggio EmiliaDepartment of General Surgery, The Rambam Academic HospitalErnest E. Moore Shock Trauma Center, University of ColoradoDepartment of General Surgery, Macerata HospitalThe Research Office, College of Medicine and Health Sciences, United Arab Emirates UniversityDepartment of General and Trauma Surgery, University Hospital of PisaDepartment of General Surgery, University Hospital of PaviaU.O.C. Chirurgia Digestiva e d’Urgenza, Azienda Ospedaliera S.MariaDepartment of General Surgery, Santa Maria del Soccorso HospitalDepartment of Surgical Sciences and Advanced Technologies, University of Catania, Cannizzaro HospitalResearch Institute at Medical University Plovdiv/University Hospital St GeorgeDivision of General and Foregut Surgery, University of Milan, IRCCS Policlinico San DonatoDonegal Clinical Research Academy, Letterkenny University HospitalDivision of Trauma and Acute Care Surgery, Department of Surgery, University of California DavisVirginia Commonwealth UniversityDepartment of Anesthesia and Intensive Care, Parma University HospitalDepartment of Digestive Surgery, Centre Hospitalier Universitaire Grenoble AlpesGovernment Gousia HospitalAcute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat HadassahGeneral Surgery Department, Military Teaching HospitalGeneral, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical CentreDepartment of General Surgery, Tan Tock Seng HospitalMedical School, National and Kapodistrian University of Athens, (NKUA)Abdominal Center, Helsinki University Hospital and University of HelsinkiDepartment of Surgery, Radboud University Medical CenterDepartment of Surgery, Radboud University Medical CenterDepartment of General and Trauma Surgery, Ethiopian Air Force HospitalDepartment of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal UniversityUnit of General and Metabolic Surgery, Clinique de St LouisCECORC Research Center, Riverside University Health System, Loma Linda UniversityDepartment of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical UniversityColorectal and Digestive Surgery Unit - DIGEST Department, Beaujon University Hospital (AP-HP)Department of Emergency Surgery, “A. Gemelli Hospital”, Catholic University of RomeDepartment of Surgery, Brody School of Medicine, East Carolina UniversityLevel I Trauma Centre, Bufalini HospitalDepartment of General and Emergency Surgery, Level I Trauma Center, Bufalini HospitalDepartment of Surgery, University Hospital of BariHealthcare Administration, Santa Maria Delle Croci Hospital, AUSL RomagnaHarborview Medical Center, University of WashingtonDepartment of Emergency and Trauma Surgery, Scripps Clinic Medical GroupDepartment of General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, eCampus University, CREAS, Ser.In.Ar. Bologna UniversityAbstract Background Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. Methods This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Results Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. Conclusion The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients. Graphical Abstracthttps://doi.org/10.1186/s13017-023-00499-3Emergency surgeryPriorityTime to surgeryDelay in surgeryHealthcare systemClassification |
| spellingShingle | Belinda De Simone Yoram Kluger Ernest E. Moore Massimo Sartelli Fikri M. Abu-Zidan Federico Coccolini Luca Ansaloni Giovanni D. Tebala Salomone Di Saverio Isidoro Di Carlo Boris E. Sakakushev Luigi Bonavina Michael Sugrue Joseph M. Galante Rao Ivatury Edoardo Picetti Mircea Chirica Imtiaz Wani Miklosh Bala Ibrahima Sall Andrew W. Kirkpatrick Vishal G. Shelat Emmanouil Pikoulis Ari Leppäniemi Edward Tan Richard P. G. ten Broek Solomon Gurmu Beka Andrey Litvin Elie Chouillard Raul Coimbra Yunfeng Cui Nicola De’ Angelis Gabriele Sganga Philip F. Stahel Vanni Agnoletti Alessia Rampini WSES TACS panel of experts Mario Testini Francesca Bravi Ronald V. Maier Walter L. Biffl Fausto Catena The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study World Journal of Emergency Surgery Emergency surgery Priority Time to surgery Delay in surgery Healthcare system Classification |
| title | The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study |
| title_full | The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study |
| title_fullStr | The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study |
| title_full_unstemmed | The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study |
| title_short | The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study |
| title_sort | new timing in acute care surgery new tacs classification a wses delphi consensus study |
| topic | Emergency surgery Priority Time to surgery Delay in surgery Healthcare system Classification |
| url | https://doi.org/10.1186/s13017-023-00499-3 |
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